In today’s world, physicians are tied to the whims of insurance companies, private equity or hospital systems that own their practices.
Unless they are in private practice (so few own their practices and those that do are finding it difficult to turn a profit) there are rubrics that state how many patients they see in a day. Control who they hire, how many and in some cases, the doctors in the practice have no control over the employees. Anything other than talking to the patient is extra, not billed and can be lengthy. It’s like an iceberg, you only see the very top.
The practice of medicine has changed drastically over the years. The older one is, the more apparent the changes.
I feel bad for doctors. Whether because of increased lawsuits and/or information overload from the internet, I don’t think they are afforded the deferential respect by patients they once had. Not that they should be revered without question, but I can’t imagine the annoyance of hearing from patients over and over again, “I read on the internet…” From the other side, they often must go to battle with insurance companies who are also questioning the necessity of what they believe their patients need. Back in the day, if the doc ordered something, it happened. There is an overall lack of trust from all sides now. There is a delicate balance between the doctor/patient relationship and the consumer mindset that patients have. Yes, the doctor is the expert, but s/he works for the patient.
Another big change has been the increase in the use of PAs and NPs. That isn’t necessarily all bad, but often MDs themselves can be extremely difficult to access. My father was a physician (a specialist). Our phone number was listed in the phone book. Patients would call him (often) on our home phone. If that is what you grew up knowing, it’s hard to get used to how different patient care is now.
Even 40 years ago, my dad would have never encouraged anyone to become a physician. His belief, “They’re all going to wind up working for the government.” Hmmm. Sort of. Add to that insurance companies and PE firms, and he really wasn’t that far off the mark.
You can get otc flu tests on Amazon, I sent them to my college kids. My daughter tested positive, texted her NP and picked up her Tamiflu in under an hour.
I sent it because it’s not easy to get appointments at the health centers and urgent cares. Our primary care at home would’ve directed us to urgent care for a flu test, not many same day appointments. However, ever since they were taken over by a big healthcare system, they seem to love to order many tests. My 23 year old was having horrible headaches when weight lifting, she had recently changed her hormone birth control. Her NP wanted here to get an MRI to rule out the worst case scenario. My daughter stopped her BC, and they went away. She called the radiology place and asked about the cost of the MRI, it’s was 100% covered but would’ve been $1000 because we haven’t hit our high deductible. My daughter then asked her NP if it was worth , was told to cancel the appointment.
Of course, since they presumably get revenue from the tests (and the insurance company gets the blame if it refuses to cover as unnecessary, regardless of whether it actually is unnecessary).
As a patient, do you feel like you are being a treated as a pawn between providers* (who want to maximize revenue from your medical treatment) and insurance companies (who want to minimize costs of your medical treatment)?
*including suppliers of pharmaceuticals and medical equipment
The unknown paper pusher/insurance companies are specifically charged with holding down healthcare costs by their clients/customers (employers and/or the government.) That is one of the primary functions insurers are supposed to serve in our current [dysfunctional] healthcare system…control healthcare costs, act as gatekeepers to control costs.
Regarding the article, it gives physicians some good tips for how to deal with patients who request inappropriate (key word) tests/medication/referrals. There is nothing wrong with patients requesting tests/medications/referrals that are appropriate.
Patients treating physicians as service providers is not going to change, that transactional relationship is fully established at this point. So, physicians and their employers have to change with the times and implement ways to deliver a positive customer experience. Many hospitals, health systems, etc track and measure customer satisfaction, as can be seen in a few of the episodes of the recent medical show The Pitt.
I’m starting to. The NP we see is young, eager, will go out of her way to contact colleagues in other specialties for advice. I also think she might be a bit naive. This same daughter had a check up, her liver enzymes were high. My daughter explained that the previous week was spring break and she definitely drank way too much, and agreed to come back the following week to redo bloodwork. At that appointment, she was sent to the local summit health mothership (10 minutes away) for a liver u/s. U/s was normal, the next day her blood work was normal. I got to pay $ for that u/s since again we hadn’t reached our deductible. There was zero need for that u/s, could’ve waited 24 hours for bloodwork results.
My kid had a lump in her breast. Went to the NP who didn’t order a mastectomy because there was no family history.
Thankfully had dinner with friends, wife is an OG/GYN and the husband is an oncologist. The wife said, I don’t think so and ordered the tests. Stage 2 cancer.
FYI there was family history and there was a genetic mutation component. Kid didn’t know, you don’t always know. Happily paid their deductible. Kid is not a big fan of PA/NP now.
So if those liver enzymes were elevated for a reason and there was an issue, it would have been fine to pay the deductible. Unfortunately you don’t know, there is a tendency to be extra cautious.
I had a spot on my shin, my PCP said it was nothing. I didn’t feel good about it so I reached out to my dermatologist who I hadn’t seen in a few years but they put me on the schedule. Melanoma. I’m so happy I was able to schedule an appointment. And that I have a PPO so that I can schedule these appointments.
That’s the problem, you just don’t know sometimes.
I would agree if the second blood test showed elevated enzymes, I’d have no problem paying oop for the u/s. Bloodwork takes 24 hours, one more day would’ve saved a lot of money. If we waited 24 hours, the u/s would not have been needed. The high liver enzymes were not unexpected, there was a valid reason. My daughter didn’t drink any alcohol between the two blood tests.
Problem is, it seems like if 25% of medical care is wasteful and unnecessary, and insurance companies deny coverage on 25% of pre authorizations and claims, it is unlikely that they deny the 25% that is wasteful and unnecessary while authorizing paying all of the necessary stuff. Instead, it seems like they deny 25% of the wasteful stuff and 25% of the necessary stuff.
In the insurance industry, “middlemen” often refer to entities like Pharmacy Benefit Managers (PBMs) and third-party administrators (TPAs) who act as intermediaries, influencing drug prices, claims, and other aspects of the healthcare system.
These are the real culprits of rising health care costs. These entities take a substantial cut to process claims and keep track of financials.
The largest pharmacy benefit manager (PBM) in the U.S. is CVS Caremark (CVS Health), followed by OptumRx (UnitedHealth Group) and Express Scripts (Cigna).
Here’s a more detailed breakdown:
CVS Caremark (CVS Health): Holds the largest market share in the PBM space.
OptumRx (UnitedHealth Group): Is the second-largest PBM.
Express Scripts (Cigna): Is the third-largest PBM.
Other significant PBMs: Prime Therapeutics, Humana Pharmacy Solutions, and MedImpact Healthcare Systems.
Market Concentration: The three largest PBMs (CVS Caremark, Express Scripts, and OptumRx) control a significant portion of the market, processing about 80% of all prescription claims.
There is a call to reform PBMs in Congress but there are a lot of hurdles.
